From the Guidelines
After cardioversion for atrial fibrillation, Eliquis (apixaban) should be continued for at least 4 weeks, as recommended by the 2019 AHA/ACC/HRS guideline update 1. The decision to extend anticoagulation beyond 4 weeks should be based on the patient's thromboembolic risk profile and bleeding risk profile. Key factors to consider in this decision include the patient's CHA₂DS₂-VASc score, which assesses stroke risk based on factors like age, gender, and medical conditions.
- The standard dose of Eliquis is 5 mg twice daily, though some patients may require a reduced dose of 2.5 mg twice daily if they meet certain criteria (age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL) 1.
- Eliquis helps prevent blood clots that could form in the heart due to irregular rhythm and potentially cause a stroke.
- Even if the heart returns to normal rhythm after cardioversion, the patient may need to continue Eliquis if they have risk factors for stroke or if their atrial fibrillation returns.
- It is crucial not to stop taking Eliquis without consulting a doctor, as doing so could significantly increase the stroke risk. The most recent and highest quality study, the 2019 AHA/ACC/HRS guideline update 1, provides the basis for these recommendations, emphasizing the importance of individualized decision-making based on the patient's specific risk factors and clinical presentation.
From the Research
Duration of Eliquis Treatment After Cardioversion for AFib
- The optimal duration of Eliquis (apixaban) treatment after cardioversion for atrial fibrillation (AFib) is not explicitly stated in the provided studies.
- However, the studies suggest that the risk of thromboembolic events after cardioversion is higher in patients with a CHA2DS2-VASc score > 1 2.
- A study published in 2016 found that patients with a CHA2DS2-VASc score > 1 benefited from oral anticoagulation prior to cardioversion, with a reduced risk of thromboembolic complications 2.
- Another study published in 2019 found that the CHA2DS2-VASc score predicts atrial fibrillation recurrence after cardioversion, with a higher score indicating a higher risk of recurrence 3.
- The American College of Cardiology recommends that patients with AFib and a CHA2DS2-VASc score ≥ 2 should receive oral anticoagulation therapy, but the duration of treatment is not specified 4, 5.
- Based on the available evidence, it is reasonable to assume that Eliquis treatment should be continued for at least 30 days after cardioversion, and possibly longer in patients with a higher CHA2DS2-VASc score or other risk factors for thromboembolic events 2, 3.